Public Health Innovation I

I’ve been focusing on pulling some thoughts together to inform the creation of a new health innovation center and along the way I’ve been reading some interesting new books that have been quite helpful. I’m going to provide some nuggets from each and how they might be brought together to create something quite useful.

The first piece is Ilona Kickbusch’s edited volume “Policy Innovation for Health”.41oj-wTFujL._SS500_ Kickbusch begins by recognizing that we have undergone a transition from acute care to managing chronic diseases that must now be approached through a broader multi-sectoral lens (yes, we hear this all the time but can you find more than a handful of interventions that actually do it or do it well?) and, news for the public health community, we have to do this through partnerships with the private sector. Innovation in this new context will revolve around the following variables: affordability, quality, and efficiency. The problem with what we call innovation in the health sector has too frequently been about short-term reorganization of health care systems that lack any kind of long-term perspective. The OECD perspective on health innovation is rather typical–genetics and biotech remain the focus or framing disciplines/sectors for where innovation lies (OECD should really take a hard look at the numbers for biotech, they’re actually not that impressive to date). Framing health and health innovation is an important first step and to do that properly we must recognize that the boundaries of health are fluid and that most attempts at thinking about health innovation remain within the health system.

The organization of health is increasingly separated from the management of disease and illness so we’ll need to think about the health impact of policies ACROSS the policy spectrum (ie. transportation, agriculture, built environment, etc.). Most health professionals who still do not exist in the paleolithic age get this, but doing it is another thing. There are some examples such as the Canadian Index for Well-Being that have tried to create frameworks for putting this broader approach into place. And I like what this means for how we need to rethink what we mean by innovation (or what I am increasingly referring to as social innovation). Or, Kickbusch and colleagues term the “innovation of innovation”–health innovations change society but the societal processes of innovation in health changes the nature and characteristics of innovation. Or, as science and technology scholars may have it, innovation and health are mutually constituitive.

Open innovation as a paradigm for health is coming fast but faces some hurdles in the health sector. Even though we have a culture of peer review in medicine, medical organizations are far from transparent. This will get interesting in the US as the Obama Administration tries to bring more transparency to all sectors of government. We’re bound to hear the old story of how health is different and the privacy flags will go up to try to stop the conversation dead in it’s tracks. Nevertheless, open innovation demands a more networked governance model, greater attention to social determinants of health and greater reliance or partnerships (or I prefer networked models over traditional partnerships). And we do see some interesting efforts to put this into place such as the “Nordic Region as a Global Health Lab” project that aims to focus on prevention and build strong civil society organizations, open data, innovative science environments, and user-led innovation platforms to drive innovation in the health sector.

I’ve been working on the open health paradigm for the past several years and appreciate the attention this book gives to the proliferation of new sensors, diagnostics and mobile devices that are increasingly creating the tools and ability to create platforms for user-led innovation in the health sector. Recently I’ve been thinking about how we can build on the AppsforDemocracy.Org experience and build something akin to “AppsforHealth” to solve citizen-generated problems, for example in the Healthy Cities format. These authors point out that a focus on building health literacy will be important. However, I think this is going to have to be a two-way street–health professionals need to learn a lot more about actually existing and lived experience of chronic diseases and their broader context through, what the authors of this book view, PPPPs, that is, public-private partnerships with PEOPLE. Through true partnerships we can begin to build greater transparency and understanding of the social and environmental determinants of disease and give people the tools to see the connections. We talk a lot about the concept of “dashboards” in sustainability, such as the mpg dashboard in the Prius, or smart grids for the home to monitor electricity consumption. What would these look like in health given the rapid pace of development in the mobile health/bluetooth device space in health?

Networked governance and what the authors refer to as “Virtual Reorganization by Design” are going to be central to innovating in health in the future. First on the table is how to build networks across sectors and build trust, commitment and share risk are some of the issue that will need to be developed. And there are also different types of networks in terms of structure and function that will need to be considered. Some of the key competencies required to design and maintain these networked structures will range from the ability to manage non-hierarchical domains, managing interdependencies of stakeholders and having the ability to manage multiple roles and accountabilities across time and space. Furthermore, networked organizations require a change in thinking from one that focuses on inputs and outputs to a perspective informed by thinking in terms of investments and outcomes. Managing the white spaces in networks becomes extremely important since this is often where new innovations are discovered.

Much of the thinking about innovation in health has been about technologies. Witness the interest in social media and mobiles in health at the moment. But it is important to recognize that even in these areas, innovation is not just about the technologies. I don’t know how many mobile health conversations I’ve had of late where the consensus has been that we need policy innovation desperately for this space to take off and have the impact that we’re hoping for. Kickbusch et al. are correct to point out that innovation in health is not about technology, but rather creating value in a knowledge society. What this means in mobile health/health 2.0 and then some, is that we’re in a historical moment when we need to think about managing the mass customization of health information and creating tools to enhance health and digital literacies that lead to citizen (not that ridiculous health consumer fantasy) empowerment.